LA County leaders press forward to amend state law to help ‘gravely disabled’ homeless

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Bearing cuts all over his face, a homeless drug addict, who said his name is April Jane, aimlessly stares into space on a sidewalk in the Skid Row area of downtown Los Angeles, Thursday, Nov. 2, 2017. No one shares the same story how they ended up in the center of poverty and despair. The streets are ruled by drugs day and night. Help exists, but too many turn to drugs to cope with their problems. (AP Photo/Jae C. Hong)

The 80-pound homeless woman who lives on Skid Row has cancer. She also has been stabbed three times.

But she can’t be taken to a hospital by social workers. Current state law says even if she’s been diagnosed with a mental illness and she doesn’t know she’s suffering, she has a right to refuse medical help.

“Where do outreach and services end and intervention begin?” social worker Anthony Ruffin asked the Board of Supervisors Tuesday during their weekly public meeting in downtown Los Angeles.

“In my experience, we have met people out there who are gravely disabled, but due to the law they perish on the streets,” he said as he choked back tears, telling them about the cancer stricken woman. “There’s nothing we can do right now but watch this slow death. It is emotionally draining and it also brings our moral obligation to light.”

Faced with a growing number of such stories on Los Angeles County’s streets, the Board of Supervisors voted 4 to 1 Tuesday to sponsor legislation that would allow social workers such as Ruffin and members of law enforcement to determine if a homeless person is “gravely disabled” enough to be detained and taken into medical care.

That means the county will pursue amending a state code to expand the definition of gravely disabled, which currently reads: “a condition in which a person, as a result of a mental health disorder, is unable to provide for his or her basic personal needs for food, clothing, shelter, or medical treatment where the lack of failure of such treatment may result in substantial physicial harm or death.”

In their joint motion, Supervisors Kathryn Barger and Mark Ridley-Thomas want to add the phrase “or medical treatment,” to that list. There are 37 other states that have language similar to what the county is proposing, Barger said.

“Allowing the most vulnerable to languish and even die on the streets without a lifeline to medical care is inhumane,” Barger said. “With today’s action, we can move forward to employ an effective approach to help deliver lifesaving treatment and care for those desperately in need and add California to 37 other states who consider medical treatment a basic human need for those suffering from a mental illness.”

Barger said pursing the amended language to the definition of gravely disabled was needed, because along with the increasing number of homeless people living on Los Angeles County’s streets, the number who died doubled in the last five years, rising to 831 deaths in 2017, according to a recent report.

Many of those deaths were deemed preventable, according to the report compiled by the county’s Department of Mental Health

While there is no definitive conclusion, at least 28 percent of the nearly 58,000 homeless people county on Los Angeles County’s streets and in shelters last year reported having been diagnosed with a mental illness.

Ridley-Thomas said amending the state definition of gravely disabled is one piece of a multi-dimensional approach the county can take to help the most vulnerable.

” The status quo is not working and in fact it’s unacceptible,” he said. “This is inot a one dimensial pursuit. This is complementary in a terms of a range of things that need to happen.”

Parents and relatives who testified to the Board Tuesday agreed with the amended language, saying more was needed to help their sons and daughters, brothers and sisters from dying on the streets when they don’t even know they are suffering.

Sandy Carlson said her son cycles in and out of court and then is back onto the streets. She supported the Board’s efforts.

“Maybe my son will be able to have his life saved,” she told the Board. “My son suffers frm lack of insight. He does not know he is seriously mentally ill.

Brittney Weissman, Executive Director of National Alliance on Mental Illness (NAMI), said her agency is in support of the expanded definition of gravely disabled as well, because it also will help families, providers and law enforcement.

“They want a positive outcome for the person they’re engaging, but the limits of the law insist they turn away from providing lifesaving help,” Weissman told the Board. “We have done much in our county over the last two years to help people who are justice-involved and live with serious mental illness and/or substance use disorders. We need to energize the same committment to reforming our mental health system.”

But Supervisor Sheila Kuehl, who cast the lone no vote, said she remained concerned with the amended language and how it affects self-autonomy and civil rights.

She questioned if the system in place is good enough to support people taken away. For example, many homeless people have pets, and being forced into treatment or a hospital means they would leave dogs and cats behind.

“It is troubling to some people,” she said.

In addition, there’s been a history of forced treatment on some communities.

Kuehl listed forced sterilization in prisons as an example, as well as LGBTQ youth who were placed in mental institutions as examples of civil rights violations.

“We must have safeguards in place,” she added.

Delilah Niedbalec, 23, said she’s been homeless for two years. She opposed the amended language, she told the board, because hospitals don’t treat homeless people well.

Asked to address those concerns, Dr. Jonathan Sherin, director for the county’s Department of Mental Health, told the board he has reached out to civil rights groups and others to help craft legislation. About 80 percent agree with the language, but 20 percent do not, and he said he’s open to learning about their concerns.

“I don’t see this as an expansion of grave disabilikty, but a clarification” he said to the supervisors. “Physical deterioration or risk of death are indicators that self care is not intact. I am like all others, very focused on how this will be implemented.”